Affinity Health Plan

    • 2016 HepC Treatment

      Hepatitis C Coverage Expansion

      Affinity Health Plan has recently expanded coverage of Hepatitis C treatment.

    • QHP Welcome Banner - Young Woman at Coffee Shop

      Welcome New Members!

      Thank you for choosing Affinity. Now that you’ve enrolled in an AffinityAccess Plan, here’s what you will need to know.

    • QHP Members

      Renew your health plan today!

      Make sure your health coverage continues without a break. New this year: lower premiums & a larger network!

    • Learn About Your Urgent Care Options: You Have Choices

      When an Urgent Care Center is Best

      Urgent Care Centers are faster and less expensive than Emergency Rooms. But, when is Urgent Care a better choice? Learn what makes sense.

  • Customer Service

    Have a question about how your plan works? Don’t see what you’re looking for? We’re here to help!

    Call Us:
    (888) 543-6973 | Fax: (718) 536-3386
    TTY/TDD: (800) 662-1220

    Mon-Fri: 8:00 AM - 6:00 PM EST

    Visit an Affinity Community Service Centers (CSC)

    Access Your Account Online

    Set up and manage your personal account options, including:

    • View/pay your monthly bill
    • Schedule automatic payments
    • Select/change your PCP
    • Print a temporary ID card
    • Review your benefits
    Log in or create an account
    Payment Options
  • Healthy Streets Spring/Summer 2015

    Member News & Alerts

    • Hepatitis C Treatment

      Expanded coverage for Hepatitis C Treatment Learn More

    • Affinity Blog

      Get the latest health information and tips on healthy living. Read the latest post

    • Key Enrollment Dates More

      • November 1, 2016: Open enrollment starts for 2017 coverage
      • December 17, 2016: The last day to enroll and have coverage begins on January 1, 2017
      • December 31, 2016: Health care coverage ends for 2016 plan year
      • January 1, 2017: The first day when 2017 coverage starts if payment is received by January 10,2017
      • January 15, 2017: The last day to enroll and have coverage begin on February 1, 2017
      • January 31, 2017: Open enrollment ends for the year, except under special circumstances

    • Renew Your Coverage More

      If you signed up to an AffinityAccess Qualified Health Plan last year though affinitystoreonline.com, your current coverage will be automatically renewed on January 1, 2017, as long as you continue to be eligible for coverage. However, you do have the option to choose another policy. Click here for information on renewing your plan.

    • Schedule of Benefits More

      For AffinityAccess and AffinityAccess Direct Members

      2017 AffinityAccess Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

      2017 AffinityAccess 2.0 Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

      2016 AffinityAccess Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

      2016 AffinityAccess 2.0 Plans:

      *For members who are 65 and older, AND ineligible for Medicare, AND ineligible for Essential Plan

    • Member Handbooks More

      Click below for information on how your AffinityAccess Qualified Health Plan works. Find out how to get care when you need it, what services are covered, or who to talk to when you have a question, so you can get the most out of your coverage.

      2017

      2016

    • Treatment Cost Calculator More

      This Treatment Cost Calculator will help you better understand the potential costs of obtaining health care services when you need treatment. In English | En Español

    • Payment Instructions More

      Now that you have confirmed your Affinity Qualified Health Plan selection, you can begin submitting your payments to us in the following ways:

      Online Payments (Fastest and Easiest Method)

      For 2017 plans, you can make your monthly payment online, right now, by check, credit or debit Visa, MasterCard, or Discover, 24 hours a day, 7 days a week.

      Other Methods of Payment

      By mail:
      Send a check or money order to:
      Affinity Health Plan
      P.O. Box 417993
      Boston, MA 02241-7993
      Please include your member ID number in the memo area of your check.

      By phone:
      Pay with your credit/debit card or eCheck (a payment you make directly from your bank account)

      Call our customer service department at 888.543.6973. We are available Monday through Friday, 8:00am - 7:00pm EST.

      You can also access our Automated Payment Line at the same number 24 hours a day, 7 days a week.

      Maintaining Coverage

      When you first enroll in your plan, there is a 10-day grace period for your first payment. This means that you will have until the 10th day of the month your coverage begins to make your first payment. If your first payment is not received within 10 days, your plan may be cancelled. For all other months your payment is due by the 1st of every month.

      Enrollment is not effective until Affinity receives your first premium payment and sends a confirmation to the New York State of Health (NYSoH). The date when both actions are complete will be considered your "Coverage Effective Date."

      If you fail to make your monthly premium payments during the plan year, your coverage may be terminated retroactively to the last date to which a payment applies.

    • Member Forms More
    • Subscriber Contracts More
    • Important Numbers and Contacts More

      Call, write, fax or follow the Web links to get answers from Affinity regarding our Qualified Health Plans (QHP):

      To Research or Buy a Plan
      Phone: (866) 731-8001; Mon-Fri 8:00 am – 6:00 pm (Eastern Time)

      Customer Service
      Phone: (888) 543-6973; Mon-Fri 8:00 am – 6:00 pm (Eastern Time)

      Claims
      Phone: (888) 543-6973; Mon-Fri 8:00 am – 6:00 pm (Eastern Time)

      Pre-authorization
      Phone: (888) 543-9074; Mon-Fri 8:30 am – 5:00 pm (Eastern Time)

      Medical Emergency: 911

      Hospitalizations: (888) 543-9074

      Beacon Health options:www.beaconhealthstrategies.com
      Phone: (888) 438-1914

      Dental:www.dentaquest.com
      Phone: (866) 731-8004

      Laboratory Services

      BioReference Laboratories: 800.229.5227
      GeneDX: 888.729.1206
      GenPath Women’s Health: 800.633.4522
      GenPath Oncology: 800.627.1479

      Empire City Laboratories, Inc.: 718.788.3840

      LabCorp: 888.522.2677
      Integrated Oncology: 800.710.1800
      Dianon Systems, Inc.: 800.328.2666
      Integrated Genetics: 800.848.4436
      Litholink Corporation: 800.338.4333
      MedTox Laboratories, Inc.: 800.832.3244
      Monogram Biosciences, Inc.: 800.777.0177

      Lenco Diagnostic Lab: 855.870.0097

      Spectra (including Shiel Medical Lab): 800.553.0873

      Sunrise Medical Laboratories: 800.782.0282

      Xeron Clinical Laboratories: 718.762.3310

      Quest Diagnostics, Inc.: (coming soon)

      Superior Vision:www.superiorvision.com
      Phone: (866) 810-3312

      CVS Caremark Pharmacy:www.caremark.com
      Phone: (855) 722-6228 (Customer Care)
      (877) 432-6793 (Authorization)
      (888) 543-9069 (Appeals)

      Paper Claims:
      AffinityAccess Claim Unit
      PO Box 981650
      El Paso, TX 79998-1650

      Claims by Telephone
      Phone: (888) 543-6973; Fax: (718) 536-3386

      Complaint, Grievance & Appeal Unit (CGA) Including Expedited
      Phone: (888) 543-9069; Fax: (718) 536-3358

    • Wellness Programs More

      Exercise Facility Reimbursement
      We will partially reimburse the Subscriber and the Subscriber’s covered Spouse for certain exercise facility fees or membership fees but only if such fees are paid to exercise facilities that we have an agreement with and which maintain equipment and programs that promote cardiovascular wellness.

      Memberships in tennis clubs, country clubs, weight loss clinics, spas or any other similar facilities will not be reimbursed. Lifetime memberships are not eligible for reimbursement. Reimbursement is limited to actual workout visits. We will not provide reimbursement for equipment, clothing, vitamins or other services that may be offered by the facility (e.g., massages, etc.).

      In order to be eligible for reimbursement, you must:

      • Be an active member of the exercise facility; and
      • Complete 50 visits in a six (6)-month period

      In order to obtain reimbursement, at the end of the six (6)-month period, you must submit:

      • Documentation of the visits from the facility. Each time you visit the exercise facility, a facility representative must sign and date the documentation of the visits
      • A copy of your current facility bill which shows the fee paid for your membership

      Once We receive documentation of the visits and the bill, you will be reimbursed the lesser of $200 for the Subscriber and $100 for the Subscriber’s covered spouse or the actual cost of the membership per six-month period. Reimbursement must be requested within 120 days of the end of the six (6)-month period. Reimbursement will be issued only after you have completed each six (6)-month period even if 50 visits are completed sooner.

      Fitness Reward Reimbursement Form  

      Breathe Easy Asthma Program
      Patient adherence to Asthma medication is a major problem in chronic disease management. Affinity’s efforts are to educate and empower our Members to take charge of their asthma care.

      Eligibility. Members who have been diagnosed with Asthma and are prescribed an Asthma controller medication in 2017 enrolled in Affinity Health Plan at the time of participation in the Breathe Easy Program. The gift card is sent when Affinity Health Plan receives confirmation that the member has completed the Breathe Easy Asthma Program between January 1 and December 31, 2017.

      Rewards. Receive a $25 Gift Card.

      Medication Management for People with Asthma
      Affinity’s efforts are to help members better understand medication adherence and the factors affecting their Asthma.

      Eligibility. Members ages 5 years and older who have been diagnosed with Asthma, prescribed an Asthma controller medication in 2017 and remained on their asthma medication for six (6) months or more. The gift card is sent when Affinity Health Plan receives the prescription claim from your pharmacy provider and the date(s) of your prescription fill fall between January 1 and December 31, 2017.

      Rewards. You can receive up to $50 depending on how many months you stay on your Asthma controller medication in 2017.

      • Receive a $25 Gift Card for staying on your Asthma controller medication for six (6) months
      • Receive a $25 Gift Card for staying on your Asthma controller medication for nine (9) months or more

       

      Healthy Moms & Baby Program
      Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Prenatal care can help keep you and your baby healthy. It lets your health care provider spot health problems early. It is also important to take care of yourself after delivery. Postpartum care includes managing physical and emotional challenges you may face after your baby is born.

      Eligibility. Women who gave birth during the Plan year and received 6 or more prenatal care visits during their pregnancy. The gift card is sent when Affinity Health Plan receives the prenatal care visit claim from your provider and if you are still enrolled in the Plan.
      Women who gave birth between during the Plan year and enrolled in Affinity Health Plan at the time of their post-partum visit. The gift card is sent when Affinity Health Plan receives the post-partum visit claim from your provider and the date of your post-partum visit is between 21 to 56 days after delivery.

      Rewards. You can only receive one of the following cards depending on the number of prenatal visits you had during your pregnancy:

      • $25 Gift Card for six (6) prenatal visits during your pregnancy, or
      • $50 Gift Card for greater than six (7 or more) prenatal visits during your pregnancy


      Receive a $25 Gift Card for post partum care

       

      Annual Dental Visits
      The absence of regular oral health care often leads to serious consequences affecting various systems in the body. It is important for our Members to understand and participate in their oral health care management.

      Eligibility. Members between birth and age 19 and were enrolled in Affinity Health Plan at the time of their dental visit. The gift card is sent when Affinity Health Plan receives the dental visit claim from your dental provider and the date of the dental visit is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      Breast Cancer Screening
      Early detection can often be a major weapon in the fight against cancer. Breast Cancer Screening consists of checking a Member’s breasts for cancer before signs or symptoms of the disease present themselves.

      Eligibility. Members age 35 and older and were enrolled in Affinity Health Plan at the time of their mammogram screening. The gift card is sent when Affinity Health Plan receives the mammogram claim from your provider and the date of the mammogram is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      Breast Cancer Screening
      Early detection can often be a major weapon in the fight against cancer. Breast Cancer Screening consists of checking a Member’s breasts for cancer before signs or symptoms of the disease present themselves.

      Eligibility. Members age 35 and older and were enrolled in Affinity Health Plan at the time of their mammogram screening. The gift card is sent when Affinity Health Plan receives the mammogram claim from your provider and the date of the mammogram is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      Cervical Cancer Screening
      Thousands of women are affected by cervical cancer each year. Because Cervical cancer develops over time, it is regarded as the easiest gynecologic cancer to prevent with regular screenings.

      Eligibility. Women between the ages of 21 to 65 years old and were enrolled in Affinity Health Plan at the time of their Cervical Cancer screening. The gift card is sent when Affinity Health Plan receives the cervical cytology/pap screening claim from your PCP or OBG/GYN and the date of the screening is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      Dilated Eye Exam
      Diabetic eye disease has the potential to cause severe vision loss and even complete blindness. Eye disease resulting from diabetes often lacks early symptoms. It is important to take an active role in caring for Your vision.

      Eligibility. Members living with diabetes and enrolled in Affinity Health Plan at the time of their retinal/dilated eye exam. The gift card is sent when Affinity Health Plan receives the dilated eye exam claim from your optometrist or ophthalmologist and the date of the exam is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      HbA1c Testing
      Living with Diabetes requires diligent and constant monitoring of Your overall health. Affinity aims to encourage our Members living with Diabetes to take control of their wellbeing by participating in regular testing and screening.

      Eligibility. Members living with Diabetes and enrolled in Affinity Health Plan at the time of their HbA1c blood test. The gift card is sent when Affinity Health Plan receives the HbA1c test claim from your provider and the date of the HbA1c is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      Nephropathy Screening
      The prospect of developing Kidney disease is a serious concern for every person living with diabetes. High levels of glucose, if left unchecked overtime, can damage Your kidneys. It is important to be screened regularly for early signs of Kidney disease.

      Eligibility. Members living with diabetes and enrolled in Affinity Health Plan at the time of their test for diabetic kidney disease. The gift card is sent when Affinity Health Plan receives the nephropathy test/screening claim from your provider and the date of the test/screening is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      Chlamydia Screening
      Many sexually transmitted diseases could have serious adverse effects on Members if left untreated. Chlamydia is a common sexually transmitted disease that can be easily cured. Affinity’s efforts are to educate our Members to better understand and put into practice efforts to prevent complications from Chlamydia.

      Eligibility. Members enrolled in Affinity Health Plan at the time of their Chlamydia screening. The gift card is sent when Affinity Health Plan receives the Chalmydia screening claim from your provider and the date of the Chlamydia screening is between January 1 and December 31 in 2017.

      Rewards. Receive a $25 Gift Card.

      Colorectal Cancer Screening
      Many people with colon cancer often experience no symptoms during the early stages. Regular checkups and testing can help detect the presence of the disease. Affinity encourages its Members to participate in the fight against cancer.

      Eligibility. Members between the ages of 50 to 75 years old and enrolled in Affinity Health Plan at the time of their Colorectal Cancer screening. The gift card is sent when Affinity Health Plan receives the colorectal cancer screening claim from your provider and the date of the screening is between January 1 and December 31 in 2017.

      Rewards. There are three (3) types of screenings for Colorectal Cancer. You can receive a gift card for only one of the following screenings when done in 2017:

      • $10 Gift Card for a Fecal occult blood test, or
      • $15 Gift Card for a Flexible sigmoidoscopy test, or
      • $25 Gift Card for a Colonoscopy exam

       

      Follow-up After Hospitalization for Mental Illness
      Many people suffer from some type of mental illness each year. It is important for treatment of a mental illness to continue after a Member is discharged from a hospital or a similar facility. Affinity encourages its Members to take an active role in their mental wellbeing.

      Eligibility. Members who are hospitalized for Mental Illness in 2017, and enrolled in Affinity Health Plan at the time of hospitalization and discharge between January 1 and December 31 in 2017. The gift card is sent when Affinity Health Plan receives the follow-up claim from your behavioral health provider and the date of your follow-up visit is within seven (7) to thirty (30) days after discharge from the hospital.
      A behavioral health provider can be a psychiatrist, psychologist, clinical social worker, psychiatric nurse, or licensed/certified counselor.

      Rewards. You can only receive one of the following cards depending on the number of days you follow-up with your behavioral health provider after discharge.

      • $25 Gift card for a follow-up visit within seven (7) days of discharge, or
      • $15 Gift card for a follow-up visit is between eight (8) and thirty (30) days of discharge

       

      HIV / AIDS Care
      Living with the HIV virus or AIDS requires a careful and diligent monitoring of Your overall health. Affinity aims to encourage our Members living with HIV or AIDS to take control of their health by participating in regular testing and screening.

      Eligibility. Members who are living with HIV/AIDS and enrolled in Affinity Health Plan at the time of their viral load testing. The gift card is sent when Affinity Health Plan receives the viral load test claim from your provider and the date of your test is between January 1 and December 31 in 2017.

      Rewards. Receive a $50 Gift Card.

      Annual Physical Visit to your Doctor
      Preventive care is essential in promoting a healthy lifestyle. Seeing Your doctor regularly is an essential element in preventive care. Affinity’s efforts are to encourage our Members to partake in regular physical examinations.

      Eligibility. Member enrolled in Affinity Health Plan at the time of their annual physical. The gift card is sent when Affinity Health Plan receives the claim from your provider and the date of your annual physical is between January 1 and December 31, 2017.

      Rewards. Receive a $25 Gift Card.

    • You Are Having A Baby More

      2017 Newborn Rule (effective 1/1/2017)
      Member must notify NYSOH within 60 days of birth. If notification to NYSOH happens within 60 days of birth then QHP coverage for newborn starts at the moment of birth. If notification happens after the 60 days, coverage begins on the date on which the NYSOH receives notice.

      • If the notification takes place within 60 days of birth and the parent wants the child added as a dependent to the QHP policy AND there is no CHP coverage/eligibility.
        • Newly calculated advance payments of any Premium Tax Credit and Cost-Sharing Reductions are effective the first day of the following month, unless the birth, adoption, or placement for adoption occurs on the first day of the month
        • Claims will pend until dependent (newborn) coverage is effective, and then they will pay


      • If the notification takes place within 60 days of birth and AND child is found eligible for CHP, the CHP coverage starts on the 1st day of the birth month
        • Any claims for newborn that have DOS 48-96 hours after delivery are covered under QHP subscriber policy (or subscriber and spouse policy); any claims for the newborn after that timeframe will be denied by QHP policy
        • If notification is outside of the 60 day notification window:
          • CHP coverage follows the old rule where coverage will start on the 15th day of the following month
          • NO GAP QHP COVERAGE WILL BE PROVIDED
          • It is the responsibility of the parent to notify NYSOH within 60 days of birth- any claims in this gap period will be denied and are the full responsibility of the parent
           
         
    • Special Enrollment Period More

      There are some special situations under which you, your spouse or child can still enroll for health care coverage. They include:

      • You lose health coverage – for example, your current plan expires, or you lose job-based coverage, or your COBRA ends
      • You get married, or get divorced
      • You are having a baby or adopting
      • You move to New York, or from one county to another within New York
      • You become a US citizen
      • Your income changes and your eligibility for advance payments of the premium tax credits is affected
      • See others here or watch this video

      Open enrollment for 2017 coverage runs from Nov. 1, 2016 to January 31, 2017. However, if any of the above events happen to you after the deadline, you will still be able to apply for health insurance. With more than 40,000 doctors and over 85 of the area’s best hospitals, Affinity is the right choice. And depending on your income, you may be able to get premium tax credits or lower out-of-pocket costs that reduce how much your coverage costs.

      Find out if you qualify

      Call (866) 731-8001, email us or visit us in person at one of our neighborhood retail stores. Click here to find a location near you.

      For Medicaid and CHP plans, enrollment is open year-round. To see if you qualify, contact us at (866) 247-5678 or email us.

    • Terms To Know More

      Premium

      Monthly fees paid for coverage of medical benefits during a specific time period (in most cases this is one year). Premiums can be paid by employers, unions, employees; or shared by both the insured individual and the plan sponsor (employers, union).

      Deductible

      A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and per family deductibles.

      Co-pay or Co-payment

      A fixed dollar amount made by you (the insured person) when a medical service is received, such as for a doctor’s office visit.

      Co-insurance 

      Similar to a co-pay, however, in this case you (the insured person) would pay a percentage of the cost of care that you receive; the plan would cover the rest; after your deductible has been met.

    • Additional Resources More